Addressing gender bias in global health imagery
Authors: Vandana Sharma, Jennifer Sawyer, Jennifer Scott
Journal: The Lancet Global Health (2023)

We applaud Esmita Charani and colleagues1Charani E Shariq S Pinto AMC et al.The use of imagery in global health: an analysis of infectious disease documents and a framework to guide practice.Lancet Glob Health. 2022; 11: e155-e164Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar for their analysis of global health imagery and their proposed framework to help minimise biases in visual media. As the authors explain, visual representations can perpetuate biases and stereotypes and reinforce inequities. We agree that there is a need for systematic approaches to promote equitable, empowering imagery that can challenge rather than reinforce biases, including gender biases. Simple, evidence-based tools that can be integrated into organisational processes and easily used by global-health staff and organisations would be of great value; these should be developed and tested before widespread adoption. The framework proposed by the authors, therefore, is an important leap for the global health field; however, its gender aspects could be strengthened. We suggest a more integrated, explicit and nuanced approach to considering gender within visual media, with emphasis on gender equity, using an intersectional lens. This suggestion applies to images depicting members of beneficiary groups and affected populations, but also those of organisational workplaces and staff members. For example, by moving beyond ensuring gender balance across images to representing women and men in a full range of roles and positions, norms and stereotypes can be challenged. This approach could include depicting women in positions of authority and power and showing both women and men in non-traditional roles such as men caring for children or women driving a vehicle. The International Organization for Migration recommends assessing the degree to which images are gender stereotypical or non-stereotypical and ensuring gender-sensitive language and gender-neutral terms are used in photo captions and report text.2International Organization for MigrationGender-responsive communications toolkit.https://www.iom.int/sites/g/files/tmzbdl486/files/about-iom/gender/gender_responsive_comms._toolkit_may_14.pdfDate: 2020Date accessed: December 23, 2022Google Scholar Furthermore, representations of women's bodies—from their posture, expressions, gestures, and positioning, to their clothing—are important as they can convey varying degrees of equal status and authority. Being explicit about these gender considerations in the proposed framework would help to address gender biases more directly in global health organisations and programmes. Other gender-based tools such as WHOs Gender Responsive Assessment Scale (ranging from gender unequal to gender transformative) could also provide a basis for categorising visual media.3WHOTable 1: WHO gender responsive assessment scale: criteria for assessing programmes and policies.https://www.ncbi.nlm.nih.gov/books/NBK559709/table/ch2.t1/?report=objectonlyDate: 2020Date accessed: December 23, 2022Google Scholar We agree with Charani and colleagues’1Charani E Shariq S Pinto AMC et al.The use of imagery in global health: an analysis of infectious disease documents and a framework to guide practice.Lancet Glob Health. 2022; 11: e155-e164Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar call for global health organisations, researchers, and other actors to systematically consider biases and suggest examining and addressing these broadly at all levels of the global health and humanitarian ecosystems. As part of the Humanitarian Gender Study,4The Humanitarian Gender StudyAbout.https://www.humanitariangenderstudy.org/aboutDate: 2020Date accessed: December 23, 2022Google Scholar the present authors are generating mixed-methods evidence on the prevalence and effects of gender biases among humanitarian practitioners and organisations across multiple areas of the workplace, including in visual and text-based communications materials, and are developing and testing tools to mitigate these biases. The present authors not only advocate for more research on the extent and nature of biases of all types, but also for sustained efforts to de-bias global health and humanitarian organisations at all levels—from individuals to organisational systems and processes to visual media. Addressing biases is crucial to foster equitable, inclusive, and effective work environments, global health and humanitarian programming, policies, and communications. We declare no competing interests. The use of imagery in global health: an analysis of infectious disease documents and a framework to guide practiceWe report an empirical analysis of the use of imagery by the key actors in global health who set policy and strategy, and we provide a comprehensive overview, particularly related to images used in reports on vaccination and antimicrobial resistance. The narrative currently depicted in imagery is one of power imbalances, depicting women and children from low-income and middle-income countries (LMICs) with less dignity, respect, and power than those from high-income countries. The absence of any evidence of consent for using intrusive and out-of-context images, particularly of children in LMICs, is concerning. Full-Text PDF Open Access